USPTO Patents Application 10017186

pEST AVAILABLE COPY

PATENT APPLICATION FEE DETERMINATION RECORD

Effective October 1 , 2001

Application or Docket Number

CLAIMS AS FILED - PART I

Column 2)

TOTAL CLAIMS

FOR

NUMBER FILED

NUMBER EXTRA

TOTAL CHARGEABLE CLAIMS

^inus 20=

INDEPENDENT CLAIMS

^ minus 3 =

*

MULTIPLE DEPENDENT CLAIM PRESENT

□

* If the difference in coluran 1 is less than zero, enter "0° in column 2
CLAIMS AS AMENDED - PART II

(Column 1)

(Column 2)

(Column 3)

ENTA

■i

CLAIMS
REMAINING

AFTER
AMENDMENT

■

HIGHEST
NUMBER

PREVIOUSLY
PAID FOR

PRESENT

EXTRA

NDM

Total

Minus

**

lMEI

Independent

★

Minus

_

FIRST PRESENTATION OF MULTIPLE DEPENDENT CU\IM

(Column 1)

(Column 2)

(Column 3)

ENTB

CLAIMS
REMAINING

AFTER
AMENDMENT

HIGHEST
NUMBER
PREVIOUSLY
PAID FOR

PRESENT
EXTRA

MDM

Total

*

Minus

^MEI

Independent

*

Minus

^

FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM

□

(Column 1)

(Column 2)

(Column 3)

ENTC

1 CLAIMS
REMAINING

AFTER
AMENDMENT

1 HIGHEST
NUMBER
PREVIOUSLY
PAID FOR

PRESENT
EXTRA

MDM

Total

*

Minus

**

.ME!

Independent

*

Minus

FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM

□

SMALL ENTITY
TYPE

OR

OTHER THAN
SMALL ENTITY

* If the entry in column 1 is less than the entry in column 2, write "0" in column 3.
** If the "Highest Number Previously Paid For" IN THIS SPACE Is less than 20, enter "20."
*lf the "Highest Number Previously Paid For" IN THIS SPACE is less than 3, enter "3."

RATE

FEE

RATE

FEE

BASIC FEE

370.00

OR

3ASIC FEE

740.00

X$9=

OR

X$18=

X42=

OR

X84=

+140=

OR

+280=

TOTAL

OR

TOTAL

SMALL ENTITY

OR

OTHER THAN
SMALL ENTITY

RATE

ADDI-
TIONAL
FEE

RATE

ADDI-
TIONAL
FEE

X$9=

OR

X$18=

X42=

OR

X84=

+140=.

OR

+280=

TOTAL
ADDIT. FEE

UH

TOTAL
ADDIT FEE

RATE

ADDI-
TIONAL
FEE

RATE

ADDI-
TIONAL
FEE

X$9=

OR

X$18=

X42=

OR

X84=

+140=

OR

+280=

TOTAL
ADDIT FEE

OR

TOTAL
ADDIT. FEE

RATE

ADDI-
TIONAL
FEE

RATE

ADDI-
TIONAL
FEE

X$9=

OR

X$18=

X42=

OR

X84=

+140=

OR

+280=

TOTAL

OR

TOTAL
ADDIT. FEE

The "Highest Number Previously Paid For" (Total or Independent) is the highest number found in the appropriate box in column 1 .

FORMPTO-875 (Rev. 8/01)

Patent and Trademark Office, U.S. DEPARTMENT OF COMMERCE

'A'O S RPO.Z001 482.174 / 59197